Traffic Safety-Related Priorities for Preteens and Adolescents: Extending Occupant Protection Messaging to Children Ages 8 to 15 Years.

Significant progress has been made in reducing the number of motor vehicle crash (MVC) injuries among young children in the United States. From 1996 to 2012, there was a 55% decline in MVC fatalities and a 53% decline in MVC injuries among children ages 14 and younger.[1-3] Despite this success, maintaining appropriate restraint use as children age continues to be a challenge. In 2013, 2% of children under the age of 1 year were observed to be unrestrained in a national observational study. In comparison, 11% of children ages 8 to 12 years were observed to be unrestrained.[4]

The objective of this study was, for children 8 to 15 years, to (a) identify current programs addressing occupant protection and (b) develop a set of priority questions to address gaps in research, education, and communication for occupant protection.

Methods

In March 2014, a 10-question survey was distributed to a child passenger safety practitioner network through a monthly newsletter to child passenger safety technicians managed by Safe Kids Worldwide. The objective of the survey was to identify any existing occupant protection safety education or programming for children ages 8 to 15 years. Respondents were asked if they were a Certified Child Passenger Safety Technician, and if they were involved in programs that educate parents, caregivers, and children in 3 age groups (8-10 years, 11-12 years, and 13-15 years). Open-ended questions were asked to describe the programs, and challenges and barriers they experienced when implementing or developing programs to reach this audience.

In April 2014, approximately 100 child passenger safety advocates attended the in-person workshop, “Out of Boosters—The New Frontier: Extending Occupant Protection Messaging to Reach Kids 8 to 15,” at the Lifesavers National Conference on Highway Safety. A normative group process was used to solicit information from the audience of practitioners and prioritize suggestions. Participants identified needs of children ages 8 to 10 years, 11 to 12 years, and 13 to 15 years.[5] Following a series of presentations on child development, injury patterns, available research, and an existing program that was identified from the premeeting survey, a series of 8 predetermined questions (Table 1) were posed regarding gaps in research, education, and communication. Attendees identified gaps in, and strategies to improve, these 3 areas for the 3 age groups.

Table 1.

Question prompts for attendees of workshop, “Out of Boosters–The New Frontier: Extending Occupant Protection Messaging to Reach Kids 8 to 15,” April 2014.

Research (separate out by 8-10, 11-12, and 13-15 as appropriate)
1. After hearing our speakers summarize what is known about this special population of child occupants, what questions stand out to you as unanswered?
a. Would it be appropriate and effective to combine safety messaging to save resources (eg, pedestrian/bike safety and proper belt use)?
b. When developing programs for this target group, should programs target primarily parents or kids (keep in mind that resources are limited)?
Education (separate out by 8-10, 11-12, and 13-15 as appropriate)
1. What specific educational tools or resources are needed for parents and caregivers of children in this group?
2. Where do educators and the school system play a role in child occupant protection, if any?
3. What are some opportunities we could leverage to utilize peer-to-peer efforts to reach kids in this group with occupant protection messaging/programming (eg, AAA School Safety Patrollers)?
Communications and Technology (separate out by 8-10, 11-12, and 13-15 as appropriate)
1. How can social media and other technology such as apps be used to engage caregivers of children in this target group?
2. What are some specific topics or messaging that need to be addressed in programs for parents of children in this age range?
3. At which age should messaging focus more on belt use than booster seat use for parents/kids in this age range?

All research activities were deemed exempt from review by our institutional review board.

Results

Fifty-two participants from 28 states responded to the premeeting survey. Two states (Utah and Kansas) were identified by respondents to the presurvey as providing occupant protection safety education or programming for children ages 8 to 15 years.

Eighty-four research, 120 education, and 101 communication responses were recorded from the workshop posters, extracted and condensed to between 3 and 5 concepts for research, education, and communication. Responses were distilled into priority topics identified in Table 2.

Table 2.

Research, education, and communication priorities identified in responses from workshop attendees

	Children Ages 8 to 10	Children Ages 11 to 12	Children Ages 13 to 15
Research	• Develop strategies to change the behavior of parents, grandparents, and caregivers	• Develop strategies to reach high-risk and diverse populations	• Create strategies to reach parents with children this age
	• Identify when the conversation begins between children and caregivers about the transition out of booster seats	• Identify how many children in this age group actually fit in a seat belt	• Evaluate effectiveness of peer-to-peer education
	• Create strategies to keep parents and children interested in staying in a booster seat as long as possible	• Determine the key influencers in youth, how to reach them, and how to motivate youth to change behavior and learn a new skill	• Understand how young teens can maintain safe behavior when with their peers
	• Design messages tailored to various at-risk groups, such as divorced parents, younger parents, and American Indian/Alaska Native communities	• Examine when parents lose the role of being the parent and when children gain control over their parents	• Examine the best way to reach young teens
	• Understand reasons why parents move a child to a seat belt, such as result of peer pressure, personal experience, because they want the child to sit in front	Identify the health care provider’s role in occupant protection at this age	• Examine the motivators for this generation, and how they communicate with their parents from other generations
Education	• Explore peer-to-peer and mentorship	• Determine if it is best to use after-school or in-school programs, and how to get the curriculum to address this issue so that it meets school regulations/requirements	• Identify how to partner with a national organization that has a connection with schools
	• Explore curbside intervention/education (drop off and pick up)	• Identify the best forum to educate parents and who should deliver the message	• Identify role model behaviors with a culture of safety with parents as a target audience
	• Identify evaluated programs with lesson plans and handouts for students, parents and staff, focusing on seat belt fit not age	• Identify the best forum to reach children, once we learn how to communicate to them	• Evaluate peer-to-peer education led leadership groups
	• Support proper restraint use in the district through uniform messaging		• Identify ways to give children a platform and empower them
	• Change social norms through PSAs, parent meetings, enforcement		• Incorporate a CPS awareness course in conjunction with required community service
Communication	• Develop apps that include safety indirectly, such as incorporating in existing game apps	• Determine if social media is the place to get information or give information, and if who delivers the information matters	• Identify what is their source of information
	• Explore social media for parents/caregivers and children through different messaging and platforms	• Identify if there is a benefit to rewarding or recognizing appropriate behavior, and what is the reward or recognition that works	• Identify mobile apps that are used by children this age
	• Develop in-vehicle technology including front and back seat, for all passengers	• Understand if there are good technology tools like simulators or games that children could use to learn more	• Examine how insurance companies can provide incentives and discounts when using a mobile app
	• Inform messaging on popular children’s television and radio channels		• Explore how to reach diverse populations, cultures, ethnicities
	• Reinforce that parents need to be parents

Discussion

The workshop identified several priority themes across age groups in the areas of research, education, and communication relating to occupant behaviors for children ages 8 to 15 years.

Research Priorities

Participants identified a need to better understand how to drive behavior change among parents and children, especially for at-risk and vulnerable groups. In particular, participants highlighted the need to explore the role of parental authority in restraint use for their children. Another identified research priority was determining the proportion of children over the age of 8 who should be using booster seats given their height. The 2013 National Survey of the Use of Booster Seats (NSUBS) found that 59% of children who were 37 to 53 inches tall were riding in car seats or booster seats; the remainder used seat belts (32%) or were unrestrained (8%).[4] Additionally, more research is needed to explore successful education and messaging to vulnerable groups: in 2013 the highest rate of restraint use among children ages 8 to 12 years was among white non-Hispanics (95%) and the lowest was among black non-Hispanics (69%).[4] Other vulnerable populations not captured in the NSUBS, but identified as possible high risk by conference participants, include divorced and young parents.

Educational Priorities

A common theme among identified educational priorities was the need to explore effective interventions in occupant protection for older children and adolescents, such as peer-to-peer models. Interventions that successfully promote other health behaviors include youth-led education workshops, empowerment interventions, and school-based programs with adult presenters.[6,7]

Communications Priorities

A common priority for all age groups was identifying how to reach older children and adolescents, and their parents, with impactful occupant protection messages about booster seat use, belt use, and riding in the back seat. Existing research has focused on communication and teen driving; a parent-based intervention to improve parent communication with teens was found to have a positive effect on reducing risky driving scores.[8] Another priority area for participants was the use and utility of applications for smartphones. However, apps may be more appropriate for reaching caregivers than adolescents and teens; a study found that caregivers were more likely to search for health-related topics on their phone and have medical apps than teens.[9] Social marketing campaigns have been found to be effective in increasing booster seat utilization rates when combined with caregiver education and distribution of booster seats;[10] extrapolating such campaigns to children out of boosters, but not yet driving, may be potentially successful.

The results from this preconference workshop indicate that there is interest and need in the traffic safety community to develop and evaluate interventions to promote safe occupant behaviors in children ages 8 to 15 years. Further efforts can focus on priorities in the areas of research, education, and communications, with the ultimate goal of reducing the number of MVC-related injuries and deaths in children and adolescents.